Julia Ellifritt and her 16-year-old daughter Lian sit on the couch in their living room. Julia, 51, is like many mothers and doesn't take care of herself like she does her children. But when her daughter needed an emergency trip to Parma Community General Hospital, the consulting surgeon noticed the mother did not appear well herself.Joshua Gunter, The Plain Dealer

When Ellifritt’s 16-year-old daughter, Lian, who was never sick,
crawled into her mother’s bed screaming in the middle of the night in
May, the two drove to Parma Community General Hospital, where Dr. Peter
Carrillo quickly diagnosed the daughter with an
acute appendicitis attack.

Then he looked at Ellifritt.

“I don’t think she had seen a doctor in forever,” Carrillo says, adding that he sees a lot of patients like her.

The 51-year-old single mother had been throwing up off and on for about six weeks. Her face was yellow with jaundice.

Carrillo recalls: “She looked sick, more sick than her daughter.”

While Ellifritt’s daughter and 15-year-old son, Nate, had annual
checkups every year, Ellifritt couldn’t tell the doctor the last time
she’d had one. So when she had become sick weeks earlier, Ellifritt did
not have a relationship with a primary care doctor
she could easily call.

“Moms always come last,” Ellifritt says, explaining her negligence.
“Once you have a kid, it’s not about you anymore. I just didn’t take
care of myself.”

Ellifritt, and too many others, doctors say, don’t have a primary
care doctor, and thus fail to get the annual preventive care screenings
and regular tests that the federal government recommends, putting them
at potential risk for serious health issues.

For women, the U.S. Department of Health and Human Services suggests
regular breast, cervical and colorectal cancer screening and checkups
that include cholesterol, blood-pressure and bone-density tests as well
as other measures.

For men, the agency recommends regular screenings for colorectal
cancer and diabetes, regular cholesterol and blood-pressure tests and
other measures.

A study published by Kaiser Permanente in the December issue of
Health Affairs found that roughly 1 in 5 of their health insurance
members in California said they had delayed or avoided a preventive
office visit, test or screening because of cost. Many
believed their high-deductible health insurance plan would cause them to
pay more out of pocket.

Special efforts to educate consumers about plans’ coverage of
preventive care may be necessary, the article’s summary notes.

Under laws passed as part of the 2010 Affordable Care Act, many
private insurers pay for most preventive measures, such as annual
wellness checks and cancer screenings. The Cleveland Clinic’s Dr. Raul
Seballos said concern about cost and lack of time are
top reasons people skip their annual exams. But fear is the No. 1 reason
because “they would rather put their head in the sand,” he says.

Seballos, who is vice chairman of preventive medicine at the
Clinic’s Wellness Institute, says that often patients “don’t know the
real importance of preventive medicine. Our philosophy in preventive
medicine is to try to diagnose a preventive illness before
it arrives.”

Several years ago, hospital systems in the Cleveland region and nationally began to
change the way they provide care for patients by introducing the
“medical home.” The concept gives patients access to a team of people
around a primary care provider. Members of the team
make sure patients attend their wellness checkups, arrange appointments
with specialists and work with them to keep chronic illnesses, such as
diabetes, under control.

More recently, state and federal officials have moved to expand the
concept, offering extra payments to physicians and hospitals if they
show improved patient care through a medical home, as research shows
that patients who receive preventive care are less
likely to need costly emergency services.

Ellifritt, who juggles a full-time job and the care of Lian and
Nate, had rationalized that her stomach pain and vomiting were symptoms
of a bad case of the flu. Having no known chronic conditions, she
hadn’t seen a doctor in at least a decade.

“I would be fine for a couple of days and then I would throw up and
stay home from work for a day,” she says. “I’m not stupid. If I thought I
was gravely ill, I would have gone to the doctor.”

Carrillo, an independent general surgeon who practices primarily at
Parma, and once worked in critical care at Mt. Sinai Medical Center,
knew at a glance that this wasn’t a bad case of the flu. He sent
Ellifritt to a nearby exam room and started asking questions.
And he noted the pain in her upper right abdomen.

A few laboratory tests later, Carrillo determined that Ellifritt had
an unusual type of bacterial infection, methicillin-resistant
staphylococcus aureus, or MRSA, in her gallbladder.

Ellifritt’s condition was severe after weeks of illness. Carrillo
determined he needed to immediately remove her gallbladder to save her.
After surgery, he kept her on antibiotics.

Carrillo also referred her to an OB-GYN for her annual checkup.

To be sure, an annual exam would not have caught the MRSA, Carrillo
says. But having a relationship with a doctor would have improved the
odds of Ellifritt receiving care sooner.

“You see it so often — people wait,” he says, adding, “I see them
when they have colon cancer, and that could have been caught earlier if
they had a colonoscopy.”

Since May, Ellifritt has seen a primary care doctor and says she learned her lesson the hard way.

“Obviously, I want to be around long enough to have grandkids,” Ellifritt says. “This was a wake-up call for me.”

Clues to Cancer: Patients, doctors on road to discovery

For 10 months, Plain Dealer reporter Angela Townsend and photographer Lynn Ischay followed 9 patients through their journey as study participants in Phase 1 trials at University Hospitals. We tell their stories here.

Follow Us

cleveland.com is powered by Plain Dealer Publishing Co. and Northeast Ohio Media Group. All rights reserved (About Us).The material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of Northeast Ohio Media Group LLC.